Hypersensitivity reactions and other complications due to Lasparaginase in the treatment of acute lymphoblastic leukemia according to ALL IC 2002 protocol

Konference: 2009 34st Congress ESMO a 15th Congress ECCO - účast ČR

Kategorie: Maligní lymfomy a leukémie

Téma: Poster Session VII: Paediatric Oncology

Číslo abstraktu: P-4119

Autoři: MUDr. Lucie Hrdličková; MUDr. Petr Říha; MUDr. Petr Smíšek; Mgr. Iveta Janotová; prof. MUDr. Jan Starý, DrSc.

Allergic reaction to all forms of L-asparaginase (ASP) is reported in 5–35% pts of various settings. We have analyzed 277 pts with acute lymphoblastic leukemia (ALL) treated according to ALL IC BFM 2002 protocol in the Czech Republic between 2002 and 2007 with the aim to evaluate the frequency, severity and other details of ASP side effects especially hypersensitivity reactions.

All pts received 8×5000 IU/m2 of ASP in the treatment induction. Those enrolled to standard (SR) or intermediate (IR) risk group were given additional 4×10000 IU/m2 in late intensification. High risk (HR) pts obtained 2×25000 IU/m2 in each of 6 cycles of reinduction chemotherapy. E. coli ASP was switched to PEG ASP in case of hypersensitivity reaction, Erwinia ASP or no other ASP form was given to pts who experienced allergic reaction to PEG ASP. All ASP forms were excluded in pts who manifested reaction to Erwinia ASP.

Allergic reaction occurred in 57 pts (20.5%) treated by E. coli ASP, representing 19.8%, 16.8% and 58.9% in SR, IR and HR group respectively. Abdominal pain, nausea, emesis, dyspnoe and skin rush were the most frequent symptoms. Out of 57 hypersensitivity reactions, 35 (61.4%) appeared during the ninth dose of E. coli ASP following 8 weeks interval from preceding exposition. Hypersensitivity to PEG ASP, Erwinia ASP developed 15 pts (26.3%), 2 pts (30%) respectively. Besides hypersensitivity reactions, we documented various other side effects, out of which pancreas dysfunction/acute pancreatitis appeared in 4 (1.4%) pts. Eleven of 277 pts (3.9%) were not given all protocol listed doses of ASP due to related complications.

Hypersensitivity to all forms of ASP occurred in 20–30% pts, the most frequently in HR group which raise the question of treatment efficacy particularly in this group. Pharmacology studies focused on detection of antibodies and silent inactivation of ASP as well as front line use of PEG ASP may help to decrease frequency of allergic reaction and improve its efficacy.

VZ FNM 00064203

Publikováno v: European Journal of Cancer Supplements, Vol 7 No 2, September 2009, Page 226

Datum přednesení příspěvku: 24. 9. 2009